Individual
DIANA VONGTHASENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AAC
Contact information
Practice address
1600 S LANE ST, SEATTLE, WA 98144-2810
(206) 682-2371
Mailing address
1600 S LANE ST, SEATTLE, WA 98144-2810
(206) 682-2371
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102063447
PREMERA
—
Enumeration date
01/05/2019
Last updated
01/05/2019
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